- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $45.71 / $56.23
| Facility | 26 | $28.18 | $45.71 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $177.83 / $562.34
| Professional | | $125.89 | $177.83 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $147.91 / $213.80
| Professional | | $117.49 | $147.91 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $117.49 / $239.88
| Professional | | $31.62 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $229.09 / $331.13
| Professional | | $208.93 | $229.09 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.51 / $39.81 / $57.54
| Facility | 26 | $8.51 | $39.81 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $190.55 / $316.23
| Professional | | $141.25 | $190.55 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | 26 | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,023.29 / $1,258.93 / $1,258.93
| Professional | | $1,023.29 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $56.23
| Facility | 26 | $28.18 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $194.98 / $436.52
| Professional | | $131.83 | $194.98 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $120.23
| Professional | | $27.54 | $33.11 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $158.49 / $426.58
| Professional | | $38.90 | $158.49 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.91 / $40.74 / $58.88
| Facility | 26 | $8.91 | $40.74 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $194.98 / $331.13
| Professional | | $141.25 | $194.98 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $162.18 / $269.15
| Professional | | $123.03 | $162.18 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $154.88 / $181.97
| Professional | | $147.91 | $154.88 | $181.97 |